BACKGROUND Due to the complexity and numerous comorbidities associated with Crohn’s disease(CD),the incidence of postoperative complications is high,significantly impacting the recovery and prognosis of patients.Cons...BACKGROUND Due to the complexity and numerous comorbidities associated with Crohn’s disease(CD),the incidence of postoperative complications is high,significantly impacting the recovery and prognosis of patients.Consequently,additional stu-dies are required to precisely predict short-term major complications following intestinal resection(IR),aiding surgical decision-making and optimizing patient care.AIM To construct novel models based on machine learning(ML)to predict short-term major postoperative complications in patients with CD following IR.METHODS A retrospective analysis was performed on clinical data derived from a patient cohort that underwent IR for CD from January 2017 to December 2022.The study participants were randomly allocated to either a training cohort or a validation cohort.The logistic regression and random forest(RF)were applied to construct models in the training cohort,with model discrimination evaluated using the area under the curves(AUC).The validation cohort assessed the performance of the constructed models.RESULTS Out of the 259 patients encompassed in the study,5.0%encountered major postoperative complications(Clavien-Dindo≥III)within 30 d following IR for CD.The AUC for the logistic model was 0.916,significantly lower than the AUC of 0.965 for the RF model.The logistic model incorporated a preoperative CD activity index(CDAI)of≥220,a diminished preoperative serum albumin level,conversion to laparotomy surgery,and an extended operation time.A nomogram for the logistic model was plotted.Except for the surgical approach,the other three variables ranked among the top four important variables in the novel ML model.CONCLUSION Both the nomogram and RF exhibited good performance in predicting short-term major postoperative complic-ations in patients with CD,with the RF model showing more superiority.A preoperative CDAI of≥220,a di-minished preoperative serum albumin level,and an extended operation time might be the most crucial variables.The findings of this study can assist clinicians in identifying patients at a higher risk for complications and offering personalized perioperative management to enhance patient outcomes.展开更多
BACKGROUND This was an observational, descriptive, and retrospective study from 2011 to 2020 from the Department of Informatics of the Brazilian Healthcare System database.AIM To describe the intestinal complications(...BACKGROUND This was an observational, descriptive, and retrospective study from 2011 to 2020 from the Department of Informatics of the Brazilian Healthcare System database.AIM To describe the intestinal complications(IC) of patients with ulcerative colitis(UC) who started conventional therapies in Brazil’s public Healthcare system.METHODS Patients ≥ 18 years of age who had at least one claim related to UC 10th revision of the International Statistical Classification of Diseases and Related Health Problems(ICD-10) code and at least 2 claims for conventional therapies were included. IC was defined as at least one claim of: UC-related hospitalization, procedures code for rectum or intestinal surgeries, and/or associated disease defined by ICD-10 codes(malignant neoplasia of colon, stenosis, hemorrhage, ulcer and other rectum or anus disease, megacolon, functional diarrhea volvulus, intussusception and erythema nodosum). Descriptive statistics, annual incidence, and incidence rate(IR) [per 100 patient-years(PY)] over the available follow-up period were calculated.RESULTS In total, 41229 UC patients were included(median age, 48 years;65% women) and the median(interquartile range) follow-up period was 3.3(1.8-5.3) years. Conventional therapy used during follow-up period included: mesalazine(87%), sulfasalazine(15%), azathioprine(16%) or methotrexate(1%) with a median duration of 1.9(0.8-4.0) years. Overall IR of IC was 3.2 cases per 100 PY. Among the IC claims, 54% were related to associated diseases, 20% to procedures and 26% to hospitalizations. The overall annual incidence of IC was 2.9%, 2.6% and 2.5% in the first, second and third year after the first claim for therapy(index date), respectively. Over the first 3 years, the annual IR of UC-related hospitalizations ranged from 0.8% to 1.1%;associated diseases from 0.9% to 1.2%-in which anus or rectum disease, and malignant neoplasia of colon were the most frequently reported;and procedure events from 0.6% to 0.7%, being intestinal resection and polyp removal the most frequent ones.CONCLUSION Study shows that UC patients under conventional therapy seem to present progression of disease developing some IC, which may have a negative impact on patients and the burden on the health system.展开更多
BACKGROUND This is a secondary database study using the Brazilian public healthcare system database.AIM To describe intestinal complications(ICs)of patients in the Brazilian public healthcare system with Crohn’s dise...BACKGROUND This is a secondary database study using the Brazilian public healthcare system database.AIM To describe intestinal complications(ICs)of patients in the Brazilian public healthcare system with Crohn’s disease(CD)who initiated and either only received conventional therapy(CVT)or also initiated anti-tumor necrosis factor(anti-TNF)therapy between 2011 and 2020.METHODS This study included patients with CD[international classification of diseases–10th revision(ICD-10):K50.0,K50.1,or K50.8](age:≥18 years)with at least one claim of CVT(sulfasalazine,azathioprine,mesalazine,or methotrexate).IC was defined as a CD-related hospitalization,pre-defined procedure codes(from rectum or intestinal surgery groups),and/or associated disease(pre-defined ICD-10 codes),and overall(one or more type of ICs).RESULTS In the 16809 patients with CD that met the inclusion criteria,the mean follow-up duration was 4.44(2.37)years.In total,14697 claims of ICs were found from 4633 patients.Over the 1-and 5-year of follow-up,8.3%and 8.2%of the patients with CD,respectively,presented at least one IC,of which fistula(31%)and fistulotomy(48%)were the most commonly reported.The overall incidence rate(95%CI)of ICs was 6.8(6.5–7.04)per 100 patient years for patients using only-CVT,and 9.2(8.8–9.6)for patients with evidence of anti-TNF therapy.CONCLUSION The outcomes highlighted an important and constant rate of ICs over time in all the CD populations assessed,especially in patients exposed to anti-TNF therapy.This outcome revealed insights into the real-world treatment and complications relevant to patients with CD and highlights that this disease remains a concern that may require additional treatment strategies in the Brazilian public healthcare system.展开更多
BACKGROUND This study employed a phenomenological research approach within qualitative research to explore the challenges encountered by elderly individuals with temporary colostomies in managing their daily lives and...BACKGROUND This study employed a phenomenological research approach within qualitative research to explore the challenges encountered by elderly individuals with temporary colostomies in managing their daily lives and care needs.Protecting the anus surgery combined with temporary colostomy has emerged as a prevalent treatment modality for low rectal cancer.However,the ileostomy is susceptible to peri-stoma skin complications,as well as fluid,electrolyte,and nutritional imbalances,posing challenges to effective management.The successful selfmanagement of patients is intricately linked to their adjustment to temporary colostomy;nonetheless,there remains a dearth of research examining the factors influencing self-care among temporary colostomy patients and the obstacles they confront.AIM To investigate the lived experiences,perceptions,and care requirements of temporary colostomy patients within their home environment,with the ultimate goal of formulating a standardized management protocol.METHODS Over the period of June to August 2023,a purposive sampling technique was utilized to select 12 patients with temporary intestinal stomas from a tertiary hospital in Shanghai,China.Employing a phenomenological research approach,a semi-structured interview guide was developed,and qualitative interviews were conducted using in-depth interview techniques.The acquired data underwent coding,analysis,organization,and summarization following Colaizzi’s seven-step method.RESULTS The findings of this study revealed that the experiences and needs of patients with temporary intestinal stomas can be delineated into four principal themes:Firstly,Temporary colostomy patients bear various burdens and concerns about the uncertainty of disease progression;secondly,patients exhibit limited self-care capabilities and face information deficits,resulting in heightened reliance on healthcare professionals;thirdly,patients demonstrate the potential for internal motivation through proactive self-adjustment;and finally,patients express a significant need for emotional and social support.CONCLUSION Home-living patients with temporary intestinal stomas confront multifaceted challenges encompassing burdens,inadequate self-care abilities,informational deficits,and emotional needs.Identifying factors influencing patients’self-care at home and proposing strategies to mitigate barriers can serve as a foundational framework for developing and implementing nursing interventions tailored to the needs of patients with temporary intestinal stomas.展开更多
Intestinal malrotation occurs when there is a disruption in the normal embryological development of the bowel. The majority of patients present with clinical features in childhood, though rarely a first presentation c...Intestinal malrotation occurs when there is a disruption in the normal embryological development of the bowel. The majority of patients present with clinical features in childhood, though rarely a first presentation can take place in adulthood. Recurrent bowel obstruction in patients with previous abdominal operation for midgut malrotation is mostly due to adhesions but very few reported cases have been due to recurrent volvulus. We present the case of a 22-year-old gentleman who had laparotomy in childhood for small bowel volvulus and then presented with acute bowel obstruction. Preoperative computerised tomography scan showed small bowel obstruction and features in keeping with midgut malrotation. Emergency laparotomy findings confirmed midgut malrotation with absent appendix, abnormal location of caecum, ascending colon and small bowel. In addition, there were small bowel volvulus and a segment of terminal ileal stricture. Limited right hemicolectomy was performed with excellent postoperative recovery. This case is presented to illustrate a rare occurrence and raise an awareness of the possibility of dreadful recurrent volvulus even several years following an initial Ladd's procedure for midgut malrotation. Therefore, one will need to exercise a high index of suspicion and this becomes very crucial in order to ensure prompt surgical intervention and thereby preventing an attendant bowel ischaemia with its associated high fatality.展开更多
BACKGROUND Nonalcoholic fatty liver disease(NAFLD)has become the leading cause of chronic liver disease with increasing prevalence worldwide.Clostridioides difficile infection(CDI)remains the most common cause of noso...BACKGROUND Nonalcoholic fatty liver disease(NAFLD)has become the leading cause of chronic liver disease with increasing prevalence worldwide.Clostridioides difficile infection(CDI)remains the most common cause of nosocomial diarrhea in developed countries.AIM To assess the impact of NAFLD on the outcomes of hospitalized patients with CDI.METHODS This study was a retrospective cohort study.The Nationwide Inpatient Sample database was used to identify a total of 7239 adults admitted as inpatients with a primary diagnosis of CDI and coexisting NAFLD diagnosis from 2010 to 2014 using ICD-9 codes.Patients with CDI and coexisting NAFLD were compared to those with CDI and coexisting alcoholic liver disease(ALD)and viral liver disease(VLD),individually.Primary outcomes included mortality,length of stay,and total hospitalization charges.Secondary outcomes were in-hospital complications.Multivariate regression was used for outcome analysis after adjusting for possible confounders.RESULTS CDI with NAFLD was independently associated with lower rates of acute respiratory failure(2.7%vs 4.2%,P<0.01;2.7%vs 4.2%,P<0.05),shorter length of stay(days)(5.75±0.16 vs 6.77±0.15,P<0.001;5.75±0.16 vs 6.84±0.23,P<0.001),and lower hospitalization charges(dollars)(38150.34±1757.01 vs 46326.72±1809.82,P<0.001;38150.34±1757.01 vs 44641.74±1660.66,P<0.001)when compared to CDI with VLD and CDI with ALD,respectively.CDI with NAFLD was associated with a lower rate of acute kidney injury(13.0%vs 17.2%,P<0.01),but a higher rate of intestinal perforation(P<0.01)when compared to VLD.A lower rate of mortality(0.8%vs 2.7%,P<0.05)but a higher rate of intestinal obstruction(4.6%vs 2.2%,P=0.001)was also observed when comparing CDI with NAFLD to ALD.CONCLUSION Hospitalized CDI patients with NAFLD had more intestinal complications compared to CDI patients with VLD and ALD.Gut microbiota dysbiosis may contribute to the pathogenesis of intestinal complications.展开更多
<strong>Introduction:</strong> Cecal volvulus is a rare cause of intestinal obstruction that occurs 1% - 1.5% of all intestinal obstructions. Causes of volvulus are usually unknown but it can be due to a d...<strong>Introduction:</strong> Cecal volvulus is a rare cause of intestinal obstruction that occurs 1% - 1.5% of all intestinal obstructions. Causes of volvulus are usually unknown but it can be due to a defective peritoneal fixation of the ascending colon and cecum in 10% and secondary causes (surgical adhesions, colonic carcinoma or diverticulitis).<strong> Case Presentation:</strong> A 56-year-old woman presented with colicky abdominal pain, bilious vomiting and abdominal distention for two days, who has no history of previous surgery and no other gastrointestinal symptoms or chronic illness. On examinations, she looks ill, dehydrated, abdomen massively distended with exaggerated bowel sound but no signs of peritonitis. CT abdomen with contrast finding: type 11 cecal volvulus seen in midline to the left above the umbilicus reaching 8 cm with ileocecal junction as well as the elongated appendix is reaching the right iliac fossa. Emergency exploratory laparotomy was done and the finding was, obstructing rectosigmoid tumor with cecal volvulus. <strong>Discussion:</strong> Cecal volvulus is one of the rare causes of mechanical intestinal obstruction which required urgent surgical intervention, and it occurs due to an axial twist of the caecum, ascending colon and terminal ileum around the mesenteric pedicle.<strong> Conclusion: </strong>Radiological imaging helps in the diagnosis of cecal volvulus especially CT scan with contrast as gold standard for both diagnosis and assessment for complications. However, this should not delay the time of intervention especially if patient presented at late stage with evidence of peritonitis or bowel ischemia and surgical right hemicolectomy is the most effective treatment option. The colonic pathology always should be assessed, as it could be the primary cause of cecal volvulus.展开更多
This case report describes the radiographic and ultrasonographic findings of three surgically confirmed cases of mesenteric volvulus or intestinal torsion in dogs. In all three cases, ultrasonographic findings include...This case report describes the radiographic and ultrasonographic findings of three surgically confirmed cases of mesenteric volvulus or intestinal torsion in dogs. In all three cases, ultrasonographic findings included segmental ileus and absent or markedly reduced peristalsis of the affected small intestine, and partial loss of wall layering with increased overall echogenicity of the intestinal wall, but with normal to mildly increased wall thickening. No blood flow was detected in the affected small intestinal wall when assessed with colour Doppler. A moderate amount of peritoneal effusion was also detected with hyperechoic omental and mesenteric fat tissue throughout the peritoneal cavity. Few reports describe ultrasonographic findings of small intestinal ischemia in small animals. In all three cases presented here, ultrasound was helpful in demonstrating typical intestinal wall changes and helped to obtain the correct diagnosis of ischemic disease of the small intestine.展开更多
Donor safety is the major concern in living donor liver transplantation (LDLT), and a constant aware of postoperative morbidity should be emphasized. Between March 2002 and May 2011 we performed 435 liver transplantat...Donor safety is the major concern in living donor liver transplantation (LDLT), and a constant aware of postoperative morbidity should be emphasized. Between March 2002 and May 2011 we performed 435 liver transplantations at an our center, one hundred forty eight with living donors. Among them left lobectomy or left lateral resections were conducted in 68 cases. Symptoms of gastric obstruction were recognized in 3 out of 68 patients that underwent left lateral resection (4.4%). The patients were readmitted because of severe symptoms of vomiting and abdominal pain. An upper endoscopy was performed and revealed pyloroantral obstruction due to gastric volvulus (GV). Endoscopic therapy correction was successfully performed in all patients. Reviewing the literature, one article has reported GV in 13 out of 115 donors (11.3%), all patients were submitted to a left resection. The mechanisms underlying this complication, in LDLT scenario, have not been fully elucidated. Nevertheless, clinicians should be aware of this possible association, which could make the diagnosis of GV more likely if a living donor comes back with typical symptoms.展开更多
Hepatic hemangiomas are the most common benign tumor of the liver.Most hepatic hemangiomas remain asymptomatic and require no treatment.Giant hepatic hemangiomas with established complications,diagnostic uncertainty a...Hepatic hemangiomas are the most common benign tumor of the liver.Most hepatic hemangiomas remain asymptomatic and require no treatment.Giant hepatic hemangiomas with established complications,diagnostic uncertainty and incapacitating symptoms,however,are generally considered an absolute indication for surgical resection.We present a case of a giant hemangioma with intestinal obstruction following transcatheter arterial embolization,by which the volume of the hemangioma was significantly reduced,and it was completely resected by a left hepatectomy.A 21-yearold Asian man visited our hospital for left upper quadrant pain.Examinations at the first visit revealed a left liver hemangioma occupying the abdominal cavity,with a maximum diameter of 31.5 cm.Embolization of the left hepatic artery was performed and confirmed a decrease in its size.However,the patient was readmitted to our hospital one month after embolization for intestinal obstruction.A left hepatectomy was completed through a herringbone incision,and safely removed a giant hemangioma of 26.5 cm × 19.5 cm × 12.0 cm in size and 3690 g in weight.Pre-operative arterial embolization is effective for reducing tumor size,but a close follow-up to decide the time for hepatectomy is important.展开更多
AIM To elucidate the effects of small intestinal bacterial overgrowth(SIBO) on the severity and complications of acute pancreatitis(AP).METHODS In total,208 patients with AP as defined by the revised Atlanta classific...AIM To elucidate the effects of small intestinal bacterial overgrowth(SIBO) on the severity and complications of acute pancreatitis(AP).METHODS In total,208 patients with AP as defined by the revised Atlanta classification were admitted to Xuanwu Hospital of capital Medical University from 2013 to 2016. All patients were admitted within 72 h of AP onset. The hydrogen breath test was performed 7 d after AP onset to detect hydrogen production and evaluate the development of SIBO. The incidence of SIBO was analyzed in patients with AP of three different severity grades. The association between SIBO and complications of AP was also assessed.RESULTS Of the 27 patients with severe AP(SAP),seven(25.92%) developed SIBO. Of the 86 patients with moderately severe AP(MSAP),22(25.58%) developed SIBO. Of the 95 patients with mild AP(MAP),eight(8.42%) developed SIBO. There were significant differences in the rates of SIBO among patients with AP of different severities. Additionally,more severe APwas associated with higher rates of SIBO positivity(P < 0.05). SIBO in patients with AP mainly occurred within 72 h of the onset of AP. The incidence of organ failure was significantly higher in patients with SIBO than in those without(P < 0.05).CONCLUSION SIBO occurs more frequently in patients with MSAP or SAP than in those with MAP,usually ≤ 72 h after AP onset. Additionally,SIBO is associated with organ failure.展开更多
BACKGROUND Compared with open mesh repair,transabdominal preperitoneal(TAPP)hernioplasty results in less chronic postoperative inguinal pain and faster postoperative recovery.However,it may still lead to rare but seri...BACKGROUND Compared with open mesh repair,transabdominal preperitoneal(TAPP)hernioplasty results in less chronic postoperative inguinal pain and faster postoperative recovery.However,it may still lead to rare but serious complications.Here we report a case of intestinal volvulus with recurrent abdominal pain as the only clinical symptom,which occurred 3 mo after TAPP repair for bilateral inguinal hernia.CASE SUMMARY A 50-year-old male patient underwent laparoscopic TAPP for bilateral inguinal hernias.After the operation,he experienced recurring pain in his lower right abdomen around the surgical area,which was relieved after symptomatic treatment.Three months after the surgery,the abdominal pain became severe and was aggravated over time.The whirlpool sign of the mesentery was seen on contrast-enhanced computed tomography(CT).Laparoscopic exploration confirmed that a barb of the V-Loc™suture penetrated the peritoneum,which caused the adhesion of the small intestinal wall to the site of peritoneal injury,forming intestinal volvulus.Since there was no closed-loop obstruction or intestinal ischemia,recurrent abdominal pain became the only clinical manifestation in this case.After laparoscopic lysis of adhesions and reduction of intestinal volvulus,the patient recovered and was discharged.CONCLUSION The possibility of intestinal volvulus should be considered in patients who experience recurrent abdominal pain following TAPP surgery during which barbed V-Loc sutures are used for closing the peritoneum.Contrast-enhanced CT and active laparoscopic exploration can confirm the diagnosis and prevent serious complications.展开更多
BACKGROUND Reverse rotation of the midgut is a rare type of intestinal malrotation.Volvulus of the right colon or entire midgut,stenosis of the transverse colon and obstruction of the duodenojejunal junction are commo...BACKGROUND Reverse rotation of the midgut is a rare type of intestinal malrotation.Volvulus of the right colon or entire midgut,stenosis of the transverse colon and obstruction of the duodenojejunal junction are common complications of reverse rotation.In this study,we report the first case of intestinal obstruction associated with reverse rotation in pregnancy.CASE SUMMARY A 31-year-old woman at 362+wk gestation presented to the emergency department with progressive abdominal cramping,nausea and bilious vomiting.Abdominal ultrasound scanning showed dilatation of the bowel.Computed tomography scanning revealed features of reverse rotation of the midgut with intestinal volvulus.After consultation with the obstetrician,the pregnancy was terminated and exploratory abdominal surgery was performed.Intra-operatively,it was found that the mesentery of the colon and small intestine was insufficiently attached.The right colon and the small intestinal mesentery was twisted,and intestinal necrosis was observed.The duodenum and duodenojejunal junction were curved in front of the transverse colon,and the transverse colon passed through the tunnel behind the mesenteric root.Intestinal reverse rotation with volvulus was confirmed.The necrotic intestine was resected and small intestine mesenteric reconstruction was performed.The patient recovered after surgery.After leaving the hospital,the patient and her daughter remained well during an 8-month follow-up period.CONCLUSION We report the diagnosis,treatment and etiology of a pregnant patient with intestinal obstruction due to reverse rotation of the midgut.For similar cases,appropriate diagnosis and treatment should be carried out according to the condition of the fetus and pregnant woman.展开更多
Colonic volvulus is a relatively uncommon cause of large bowel obstruction usually involving mobile,intraperitoneal,colonic segments.Congenital or acquired anatomic variation may be associated with an increased risk o...Colonic volvulus is a relatively uncommon cause of large bowel obstruction usually involving mobile,intraperitoneal,colonic segments.Congenital or acquired anatomic variation may be associated with an increased risk of colonic volvulus which can occasionally involve retro-peritoneal segments.We report a case of 54-year-old female who presented to our Institution to perform a plain abdominal film series for acute onset of cramping abdominal pain.Both the upright and supine films showed signs of acute colonic obstruction which was thought to be due to an internal hernia of the transverse colon into the lesser sac.The patient was therefore submitted to a multi-detector contrast-enhanced computed tomography(CT).CT findings were initially thought to be consistent with the presumed diagnosis of internal hernia but further evaluation and coronal reformatting clearly depicted the presence of a colonic volvulus possibly resulting from a retro-gastric colon.At surgery,a volvulus of the ascending colon was found and a right hemi-colectomy had to be performed.However,a non rotated midgut with a right-sided duodeno-jejunal flexure and a left sided colon was also found at laparotomy and over-looked in the pre-operative CT.Retrospective evaluation of CT images was therefore performed and a number of CT signs of intestinal malrotation could be identified.展开更多
Inflammatory bowel disease and Crohn’s disease in particular,is a common cause of intestinal failure.Current therapeutic options include home parenteral nutrition and intestinal transplantation.For most patients,home...Inflammatory bowel disease and Crohn’s disease in particular,is a common cause of intestinal failure.Current therapeutic options include home parenteral nutrition and intestinal transplantation.For most patients,home intravenous therapy including parenteral nutrition,with a good probability of long-term survival,is the favoured choice.However,in selected patients,with specific features that may shorten survival or complicate home parenteral nutrition,intestinal transplantation presents a viable alternative.We present survival,complications,quality of life and economic considerations that currently influence individualised decision-making between home parenteral nutrition and intestinal transplantation.展开更多
基金Supported by Horizontal Project of Shanghai Tenth People’s Hospital,No.DS05!06!22016 and No.DS05!06!22017.
文摘BACKGROUND Due to the complexity and numerous comorbidities associated with Crohn’s disease(CD),the incidence of postoperative complications is high,significantly impacting the recovery and prognosis of patients.Consequently,additional stu-dies are required to precisely predict short-term major complications following intestinal resection(IR),aiding surgical decision-making and optimizing patient care.AIM To construct novel models based on machine learning(ML)to predict short-term major postoperative complications in patients with CD following IR.METHODS A retrospective analysis was performed on clinical data derived from a patient cohort that underwent IR for CD from January 2017 to December 2022.The study participants were randomly allocated to either a training cohort or a validation cohort.The logistic regression and random forest(RF)were applied to construct models in the training cohort,with model discrimination evaluated using the area under the curves(AUC).The validation cohort assessed the performance of the constructed models.RESULTS Out of the 259 patients encompassed in the study,5.0%encountered major postoperative complications(Clavien-Dindo≥III)within 30 d following IR for CD.The AUC for the logistic model was 0.916,significantly lower than the AUC of 0.965 for the RF model.The logistic model incorporated a preoperative CD activity index(CDAI)of≥220,a diminished preoperative serum albumin level,conversion to laparotomy surgery,and an extended operation time.A nomogram for the logistic model was plotted.Except for the surgical approach,the other three variables ranked among the top four important variables in the novel ML model.CONCLUSION Both the nomogram and RF exhibited good performance in predicting short-term major postoperative complic-ations in patients with CD,with the RF model showing more superiority.A preoperative CDAI of≥220,a di-minished preoperative serum albumin level,and an extended operation time might be the most crucial variables.The findings of this study can assist clinicians in identifying patients at a higher risk for complications and offering personalized perioperative management to enhance patient outcomes.
文摘BACKGROUND This was an observational, descriptive, and retrospective study from 2011 to 2020 from the Department of Informatics of the Brazilian Healthcare System database.AIM To describe the intestinal complications(IC) of patients with ulcerative colitis(UC) who started conventional therapies in Brazil’s public Healthcare system.METHODS Patients ≥ 18 years of age who had at least one claim related to UC 10th revision of the International Statistical Classification of Diseases and Related Health Problems(ICD-10) code and at least 2 claims for conventional therapies were included. IC was defined as at least one claim of: UC-related hospitalization, procedures code for rectum or intestinal surgeries, and/or associated disease defined by ICD-10 codes(malignant neoplasia of colon, stenosis, hemorrhage, ulcer and other rectum or anus disease, megacolon, functional diarrhea volvulus, intussusception and erythema nodosum). Descriptive statistics, annual incidence, and incidence rate(IR) [per 100 patient-years(PY)] over the available follow-up period were calculated.RESULTS In total, 41229 UC patients were included(median age, 48 years;65% women) and the median(interquartile range) follow-up period was 3.3(1.8-5.3) years. Conventional therapy used during follow-up period included: mesalazine(87%), sulfasalazine(15%), azathioprine(16%) or methotrexate(1%) with a median duration of 1.9(0.8-4.0) years. Overall IR of IC was 3.2 cases per 100 PY. Among the IC claims, 54% were related to associated diseases, 20% to procedures and 26% to hospitalizations. The overall annual incidence of IC was 2.9%, 2.6% and 2.5% in the first, second and third year after the first claim for therapy(index date), respectively. Over the first 3 years, the annual IR of UC-related hospitalizations ranged from 0.8% to 1.1%;associated diseases from 0.9% to 1.2%-in which anus or rectum disease, and malignant neoplasia of colon were the most frequently reported;and procedure events from 0.6% to 0.7%, being intestinal resection and polyp removal the most frequent ones.CONCLUSION Study shows that UC patients under conventional therapy seem to present progression of disease developing some IC, which may have a negative impact on patients and the burden on the health system.
文摘BACKGROUND This is a secondary database study using the Brazilian public healthcare system database.AIM To describe intestinal complications(ICs)of patients in the Brazilian public healthcare system with Crohn’s disease(CD)who initiated and either only received conventional therapy(CVT)or also initiated anti-tumor necrosis factor(anti-TNF)therapy between 2011 and 2020.METHODS This study included patients with CD[international classification of diseases–10th revision(ICD-10):K50.0,K50.1,or K50.8](age:≥18 years)with at least one claim of CVT(sulfasalazine,azathioprine,mesalazine,or methotrexate).IC was defined as a CD-related hospitalization,pre-defined procedure codes(from rectum or intestinal surgery groups),and/or associated disease(pre-defined ICD-10 codes),and overall(one or more type of ICs).RESULTS In the 16809 patients with CD that met the inclusion criteria,the mean follow-up duration was 4.44(2.37)years.In total,14697 claims of ICs were found from 4633 patients.Over the 1-and 5-year of follow-up,8.3%and 8.2%of the patients with CD,respectively,presented at least one IC,of which fistula(31%)and fistulotomy(48%)were the most commonly reported.The overall incidence rate(95%CI)of ICs was 6.8(6.5–7.04)per 100 patient years for patients using only-CVT,and 9.2(8.8–9.6)for patients with evidence of anti-TNF therapy.CONCLUSION The outcomes highlighted an important and constant rate of ICs over time in all the CD populations assessed,especially in patients exposed to anti-TNF therapy.This outcome revealed insights into the real-world treatment and complications relevant to patients with CD and highlights that this disease remains a concern that may require additional treatment strategies in the Brazilian public healthcare system.
基金The study was reviewed and approved by the Science and Research Office of Tong Ren Hospital(Shanghai), No. AF/SC-08/04.0.
文摘BACKGROUND This study employed a phenomenological research approach within qualitative research to explore the challenges encountered by elderly individuals with temporary colostomies in managing their daily lives and care needs.Protecting the anus surgery combined with temporary colostomy has emerged as a prevalent treatment modality for low rectal cancer.However,the ileostomy is susceptible to peri-stoma skin complications,as well as fluid,electrolyte,and nutritional imbalances,posing challenges to effective management.The successful selfmanagement of patients is intricately linked to their adjustment to temporary colostomy;nonetheless,there remains a dearth of research examining the factors influencing self-care among temporary colostomy patients and the obstacles they confront.AIM To investigate the lived experiences,perceptions,and care requirements of temporary colostomy patients within their home environment,with the ultimate goal of formulating a standardized management protocol.METHODS Over the period of June to August 2023,a purposive sampling technique was utilized to select 12 patients with temporary intestinal stomas from a tertiary hospital in Shanghai,China.Employing a phenomenological research approach,a semi-structured interview guide was developed,and qualitative interviews were conducted using in-depth interview techniques.The acquired data underwent coding,analysis,organization,and summarization following Colaizzi’s seven-step method.RESULTS The findings of this study revealed that the experiences and needs of patients with temporary intestinal stomas can be delineated into four principal themes:Firstly,Temporary colostomy patients bear various burdens and concerns about the uncertainty of disease progression;secondly,patients exhibit limited self-care capabilities and face information deficits,resulting in heightened reliance on healthcare professionals;thirdly,patients demonstrate the potential for internal motivation through proactive self-adjustment;and finally,patients express a significant need for emotional and social support.CONCLUSION Home-living patients with temporary intestinal stomas confront multifaceted challenges encompassing burdens,inadequate self-care abilities,informational deficits,and emotional needs.Identifying factors influencing patients’self-care at home and proposing strategies to mitigate barriers can serve as a foundational framework for developing and implementing nursing interventions tailored to the needs of patients with temporary intestinal stomas.
文摘Intestinal malrotation occurs when there is a disruption in the normal embryological development of the bowel. The majority of patients present with clinical features in childhood, though rarely a first presentation can take place in adulthood. Recurrent bowel obstruction in patients with previous abdominal operation for midgut malrotation is mostly due to adhesions but very few reported cases have been due to recurrent volvulus. We present the case of a 22-year-old gentleman who had laparotomy in childhood for small bowel volvulus and then presented with acute bowel obstruction. Preoperative computerised tomography scan showed small bowel obstruction and features in keeping with midgut malrotation. Emergency laparotomy findings confirmed midgut malrotation with absent appendix, abnormal location of caecum, ascending colon and small bowel. In addition, there were small bowel volvulus and a segment of terminal ileal stricture. Limited right hemicolectomy was performed with excellent postoperative recovery. This case is presented to illustrate a rare occurrence and raise an awareness of the possibility of dreadful recurrent volvulus even several years following an initial Ladd's procedure for midgut malrotation. Therefore, one will need to exercise a high index of suspicion and this becomes very crucial in order to ensure prompt surgical intervention and thereby preventing an attendant bowel ischaemia with its associated high fatality.
文摘BACKGROUND Nonalcoholic fatty liver disease(NAFLD)has become the leading cause of chronic liver disease with increasing prevalence worldwide.Clostridioides difficile infection(CDI)remains the most common cause of nosocomial diarrhea in developed countries.AIM To assess the impact of NAFLD on the outcomes of hospitalized patients with CDI.METHODS This study was a retrospective cohort study.The Nationwide Inpatient Sample database was used to identify a total of 7239 adults admitted as inpatients with a primary diagnosis of CDI and coexisting NAFLD diagnosis from 2010 to 2014 using ICD-9 codes.Patients with CDI and coexisting NAFLD were compared to those with CDI and coexisting alcoholic liver disease(ALD)and viral liver disease(VLD),individually.Primary outcomes included mortality,length of stay,and total hospitalization charges.Secondary outcomes were in-hospital complications.Multivariate regression was used for outcome analysis after adjusting for possible confounders.RESULTS CDI with NAFLD was independently associated with lower rates of acute respiratory failure(2.7%vs 4.2%,P<0.01;2.7%vs 4.2%,P<0.05),shorter length of stay(days)(5.75±0.16 vs 6.77±0.15,P<0.001;5.75±0.16 vs 6.84±0.23,P<0.001),and lower hospitalization charges(dollars)(38150.34±1757.01 vs 46326.72±1809.82,P<0.001;38150.34±1757.01 vs 44641.74±1660.66,P<0.001)when compared to CDI with VLD and CDI with ALD,respectively.CDI with NAFLD was associated with a lower rate of acute kidney injury(13.0%vs 17.2%,P<0.01),but a higher rate of intestinal perforation(P<0.01)when compared to VLD.A lower rate of mortality(0.8%vs 2.7%,P<0.05)but a higher rate of intestinal obstruction(4.6%vs 2.2%,P=0.001)was also observed when comparing CDI with NAFLD to ALD.CONCLUSION Hospitalized CDI patients with NAFLD had more intestinal complications compared to CDI patients with VLD and ALD.Gut microbiota dysbiosis may contribute to the pathogenesis of intestinal complications.
文摘<strong>Introduction:</strong> Cecal volvulus is a rare cause of intestinal obstruction that occurs 1% - 1.5% of all intestinal obstructions. Causes of volvulus are usually unknown but it can be due to a defective peritoneal fixation of the ascending colon and cecum in 10% and secondary causes (surgical adhesions, colonic carcinoma or diverticulitis).<strong> Case Presentation:</strong> A 56-year-old woman presented with colicky abdominal pain, bilious vomiting and abdominal distention for two days, who has no history of previous surgery and no other gastrointestinal symptoms or chronic illness. On examinations, she looks ill, dehydrated, abdomen massively distended with exaggerated bowel sound but no signs of peritonitis. CT abdomen with contrast finding: type 11 cecal volvulus seen in midline to the left above the umbilicus reaching 8 cm with ileocecal junction as well as the elongated appendix is reaching the right iliac fossa. Emergency exploratory laparotomy was done and the finding was, obstructing rectosigmoid tumor with cecal volvulus. <strong>Discussion:</strong> Cecal volvulus is one of the rare causes of mechanical intestinal obstruction which required urgent surgical intervention, and it occurs due to an axial twist of the caecum, ascending colon and terminal ileum around the mesenteric pedicle.<strong> Conclusion: </strong>Radiological imaging helps in the diagnosis of cecal volvulus especially CT scan with contrast as gold standard for both diagnosis and assessment for complications. However, this should not delay the time of intervention especially if patient presented at late stage with evidence of peritonitis or bowel ischemia and surgical right hemicolectomy is the most effective treatment option. The colonic pathology always should be assessed, as it could be the primary cause of cecal volvulus.
文摘This case report describes the radiographic and ultrasonographic findings of three surgically confirmed cases of mesenteric volvulus or intestinal torsion in dogs. In all three cases, ultrasonographic findings included segmental ileus and absent or markedly reduced peristalsis of the affected small intestine, and partial loss of wall layering with increased overall echogenicity of the intestinal wall, but with normal to mildly increased wall thickening. No blood flow was detected in the affected small intestinal wall when assessed with colour Doppler. A moderate amount of peritoneal effusion was also detected with hyperechoic omental and mesenteric fat tissue throughout the peritoneal cavity. Few reports describe ultrasonographic findings of small intestinal ischemia in small animals. In all three cases presented here, ultrasound was helpful in demonstrating typical intestinal wall changes and helped to obtain the correct diagnosis of ischemic disease of the small intestine.
文摘Donor safety is the major concern in living donor liver transplantation (LDLT), and a constant aware of postoperative morbidity should be emphasized. Between March 2002 and May 2011 we performed 435 liver transplantations at an our center, one hundred forty eight with living donors. Among them left lobectomy or left lateral resections were conducted in 68 cases. Symptoms of gastric obstruction were recognized in 3 out of 68 patients that underwent left lateral resection (4.4%). The patients were readmitted because of severe symptoms of vomiting and abdominal pain. An upper endoscopy was performed and revealed pyloroantral obstruction due to gastric volvulus (GV). Endoscopic therapy correction was successfully performed in all patients. Reviewing the literature, one article has reported GV in 13 out of 115 donors (11.3%), all patients were submitted to a left resection. The mechanisms underlying this complication, in LDLT scenario, have not been fully elucidated. Nevertheless, clinicians should be aware of this possible association, which could make the diagnosis of GV more likely if a living donor comes back with typical symptoms.
文摘Hepatic hemangiomas are the most common benign tumor of the liver.Most hepatic hemangiomas remain asymptomatic and require no treatment.Giant hepatic hemangiomas with established complications,diagnostic uncertainty and incapacitating symptoms,however,are generally considered an absolute indication for surgical resection.We present a case of a giant hemangioma with intestinal obstruction following transcatheter arterial embolization,by which the volume of the hemangioma was significantly reduced,and it was completely resected by a left hepatectomy.A 21-yearold Asian man visited our hospital for left upper quadrant pain.Examinations at the first visit revealed a left liver hemangioma occupying the abdominal cavity,with a maximum diameter of 31.5 cm.Embolization of the left hepatic artery was performed and confirmed a decrease in its size.However,the patient was readmitted to our hospital one month after embolization for intestinal obstruction.A left hepatectomy was completed through a herringbone incision,and safely removed a giant hemangioma of 26.5 cm × 19.5 cm × 12.0 cm in size and 3690 g in weight.Pre-operative arterial embolization is effective for reducing tumor size,but a close follow-up to decide the time for hepatectomy is important.
基金Supported by Wu Jieping Medical Foundation,No.320.6750.12120
文摘AIM To elucidate the effects of small intestinal bacterial overgrowth(SIBO) on the severity and complications of acute pancreatitis(AP).METHODS In total,208 patients with AP as defined by the revised Atlanta classification were admitted to Xuanwu Hospital of capital Medical University from 2013 to 2016. All patients were admitted within 72 h of AP onset. The hydrogen breath test was performed 7 d after AP onset to detect hydrogen production and evaluate the development of SIBO. The incidence of SIBO was analyzed in patients with AP of three different severity grades. The association between SIBO and complications of AP was also assessed.RESULTS Of the 27 patients with severe AP(SAP),seven(25.92%) developed SIBO. Of the 86 patients with moderately severe AP(MSAP),22(25.58%) developed SIBO. Of the 95 patients with mild AP(MAP),eight(8.42%) developed SIBO. There were significant differences in the rates of SIBO among patients with AP of different severities. Additionally,more severe APwas associated with higher rates of SIBO positivity(P < 0.05). SIBO in patients with AP mainly occurred within 72 h of the onset of AP. The incidence of organ failure was significantly higher in patients with SIBO than in those without(P < 0.05).CONCLUSION SIBO occurs more frequently in patients with MSAP or SAP than in those with MAP,usually ≤ 72 h after AP onset. Additionally,SIBO is associated with organ failure.
文摘BACKGROUND Compared with open mesh repair,transabdominal preperitoneal(TAPP)hernioplasty results in less chronic postoperative inguinal pain and faster postoperative recovery.However,it may still lead to rare but serious complications.Here we report a case of intestinal volvulus with recurrent abdominal pain as the only clinical symptom,which occurred 3 mo after TAPP repair for bilateral inguinal hernia.CASE SUMMARY A 50-year-old male patient underwent laparoscopic TAPP for bilateral inguinal hernias.After the operation,he experienced recurring pain in his lower right abdomen around the surgical area,which was relieved after symptomatic treatment.Three months after the surgery,the abdominal pain became severe and was aggravated over time.The whirlpool sign of the mesentery was seen on contrast-enhanced computed tomography(CT).Laparoscopic exploration confirmed that a barb of the V-Loc™suture penetrated the peritoneum,which caused the adhesion of the small intestinal wall to the site of peritoneal injury,forming intestinal volvulus.Since there was no closed-loop obstruction or intestinal ischemia,recurrent abdominal pain became the only clinical manifestation in this case.After laparoscopic lysis of adhesions and reduction of intestinal volvulus,the patient recovered and was discharged.CONCLUSION The possibility of intestinal volvulus should be considered in patients who experience recurrent abdominal pain following TAPP surgery during which barbed V-Loc sutures are used for closing the peritoneum.Contrast-enhanced CT and active laparoscopic exploration can confirm the diagnosis and prevent serious complications.
文摘BACKGROUND Reverse rotation of the midgut is a rare type of intestinal malrotation.Volvulus of the right colon or entire midgut,stenosis of the transverse colon and obstruction of the duodenojejunal junction are common complications of reverse rotation.In this study,we report the first case of intestinal obstruction associated with reverse rotation in pregnancy.CASE SUMMARY A 31-year-old woman at 362+wk gestation presented to the emergency department with progressive abdominal cramping,nausea and bilious vomiting.Abdominal ultrasound scanning showed dilatation of the bowel.Computed tomography scanning revealed features of reverse rotation of the midgut with intestinal volvulus.After consultation with the obstetrician,the pregnancy was terminated and exploratory abdominal surgery was performed.Intra-operatively,it was found that the mesentery of the colon and small intestine was insufficiently attached.The right colon and the small intestinal mesentery was twisted,and intestinal necrosis was observed.The duodenum and duodenojejunal junction were curved in front of the transverse colon,and the transverse colon passed through the tunnel behind the mesenteric root.Intestinal reverse rotation with volvulus was confirmed.The necrotic intestine was resected and small intestine mesenteric reconstruction was performed.The patient recovered after surgery.After leaving the hospital,the patient and her daughter remained well during an 8-month follow-up period.CONCLUSION We report the diagnosis,treatment and etiology of a pregnant patient with intestinal obstruction due to reverse rotation of the midgut.For similar cases,appropriate diagnosis and treatment should be carried out according to the condition of the fetus and pregnant woman.
文摘Colonic volvulus is a relatively uncommon cause of large bowel obstruction usually involving mobile,intraperitoneal,colonic segments.Congenital or acquired anatomic variation may be associated with an increased risk of colonic volvulus which can occasionally involve retro-peritoneal segments.We report a case of 54-year-old female who presented to our Institution to perform a plain abdominal film series for acute onset of cramping abdominal pain.Both the upright and supine films showed signs of acute colonic obstruction which was thought to be due to an internal hernia of the transverse colon into the lesser sac.The patient was therefore submitted to a multi-detector contrast-enhanced computed tomography(CT).CT findings were initially thought to be consistent with the presumed diagnosis of internal hernia but further evaluation and coronal reformatting clearly depicted the presence of a colonic volvulus possibly resulting from a retro-gastric colon.At surgery,a volvulus of the ascending colon was found and a right hemi-colectomy had to be performed.However,a non rotated midgut with a right-sided duodeno-jejunal flexure and a left sided colon was also found at laparotomy and over-looked in the pre-operative CT.Retrospective evaluation of CT images was therefore performed and a number of CT signs of intestinal malrotation could be identified.
文摘Inflammatory bowel disease and Crohn’s disease in particular,is a common cause of intestinal failure.Current therapeutic options include home parenteral nutrition and intestinal transplantation.For most patients,home intravenous therapy including parenteral nutrition,with a good probability of long-term survival,is the favoured choice.However,in selected patients,with specific features that may shorten survival or complicate home parenteral nutrition,intestinal transplantation presents a viable alternative.We present survival,complications,quality of life and economic considerations that currently influence individualised decision-making between home parenteral nutrition and intestinal transplantation.